Healthcare Provider Details

I. General information

NPI: 1255813374
Provider Name (Legal Business Name): LETICIA JIMENEZ-ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

9064 HILLSIDE RD
DELHI CA
95315-9338
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8880
  • Fax:
Mailing address:
  • Phone: 209-262-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: